title: Management program decreases postoperative nausea and vomiting in high-risk and in general surgical patients: a quality improvement cycle.
abstract: BACKGROUND
  Preventing postoperative nausea and vomiting (PONV) is a major priority for postsurgical patient care. Our objective was to assess the efficacy of a multimodal postoperative nausea and vomiting (PONV) approach, which was associated with a continuous quality improvement program, in maintaining a low PONV incidence in the PACU.
  
  
  METHODS
  Consecutive adult patients scheduled for surgery (ambulatory surgery or not) were prospectively included. PONV data were recorded in the PACU and over a 24-hour period. The management program was based on a multimodal approach with both changes in anesthetic techniques and anti-emetics, and on a three-stage protocol including: 1) phase I: institutional practice phase based on prospective observational study; 2) protocol implementation; 3) phase II: prospective observational study associated with feedback, scientific session and evaluation to guideline adherence. We used the Apfel risk scoring system to identify patients at high risk of PONV. Feedback with audit results and didactic sessions were scheduled quarterly in the Phase II.
  
  
  RESULTS
  Thirty-seven/395 (9.4%) and 151/3864 (3.9%) patients experienced PONV in the PACU during Phase I and Phase II respectively (P<0.001). Among the patients with an Apfel risk score that included at least two risk factors, 16.6% and 4.2% experienced PONV in the PACU during Phase I and Phase II respectively (P<0.001).
  
  
  CONCLUSIONS
  We highlight the association with a sharp decrease in PONV incidence over a one-year period and a multimodal PONV approach using feedback to clinicians associated with continuous quality improvement program.
authors.affiliation: Université de Bordeaux, Maladies Rares: Génétique et Métabolique, Bordeaux, France - karine.nouette-gaulain@u-bordeaux.fr.
authors.forename: B
authors.initials: B
authors.lastname: Kolanek
authors.forename: L
authors.initials: L
authors.lastname: Svartz
authors.forename: F
authors.initials: F
authors.lastname: Robin
authors.forename: F
authors.initials: F
authors.lastname: Boutin
authors.forename: L
authors.initials: L
authors.lastname: Beylacq
authors.forename: A
authors.initials: A
authors.lastname: Lasserre
authors.forename: M-C
authors.initials: MC
authors.lastname: Krol-Houdek
authors.forename: V
authors.initials: V
authors.lastname: Berger
authors.forename: V
authors.initials: V
authors.lastname: Altuzarra
authors.forename: O
authors.initials: O
authors.lastname: Jecker
authors.forename: M
authors.initials: M
authors.lastname: Sesay
authors.forename: P-M
authors.initials: PM
authors.lastname: Mertes
authors.forename: R
authors.initials: R
authors.lastname: Rossignol
authors.forename: K
authors.initials: K
authors.lastname: Nouette-Gaulain
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects; D000932:Antiemetics / Q000627:therapeutic use; D019090:Case Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D058996:Quality Improvement; D013514:Surgical Procedures, Operative / Q000379:methods*
chemical_list: D000932:Antiemetics